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Abstract
BackgroundResistance to contemporary broad-spectrum β-lactams, mediated by extended-spectrum β-lactamases (ESBL), is an increasing problem worldwide. Many of the emerging antimicrobial resistance problems of this decade have been characterized by difficulty in the recognition of resistance in the laboratory, particularly by rapid susceptibility test methods. The plasmid-encoded ESBL represent such a resistance phenomenon that is difficult to recognize.We compared Dio-Sensimedia-ES (DSM-ES; Diomed, Istanbul, Turkey) and Mueller-Hinton (MH) agar in the double-disk synergy test (DDST) as a novel rapid system for detecting ESBL directly from bacterial culture.MethodsSixty ESBL-producing Klebsiella pneumoniae isolates cultured from blood (30), endotracheal aspirates (20), urine (5) and pus (5), as well as 40 Escherichia coli isolates cultured from endotracheal aspirates (15), urine (10), blood (8) and pus (7) were studied. Isolates positive for ESBL by the combined disk tests were tested with the DDST using MH and DSM-ES agar to detect ESBL-mediated resistance in K. pneumoniae and E. coli. DSM-ES agar was also used to determine the susceptibility of Enterobacteriaceae and staphylococci.ResultsAmong 60 ESBL-producing K. pneumoniae isolates, 59 (98.3%) were identified as ESBL-positive by the DDST using MH, and 58 (96.6%), using DSM-ES agar. Of 40 ESBL-producing E. coli isolates, 38 (95%) were ESBL-positive by the DDST on MH agar, and 37 (92.5%), on DSM-ES agar. The average incubation period required for ESBL detection by the DDST on DSM-ES agar was 4 hours.ConclusionsSince the DDST results were available within 4 hours when DSM-ES agar was used, the use of this media may significantly lower the length of hospital stay, the total cost for patient care and even the mortality rate by fascilitating early treatment against ESBL-producing organisms.
Highlights
Resistance to contemporary broad-spectrum β-lactams, mediated by extendedspectrum β-lactamases (ESBL), is an increasing problem worldwide
Sixty ESBL-producing Klebsiella pneumoniae isolates cultured from blood (30), endotracheal aspirates (20), urine (5) and pus (5), as well as 40 Escherichia coli isolates cultured from endotracheal aspirates (15), urine (10), blood (8) and pus (7) were studied
The average incubation period required for ESBL detection by the double-disk synergy test (DDST) on DSM-ES agar was 4 hours
Summary
Resistance to contemporary broad-spectrum β-lactams, mediated by extendedspectrum β-lactamases (ESBL), is an increasing problem worldwide. Microbial resistance through extended-spectrum β-lactamases (ESBL) was first reported in Europe, and subsequently in the United States. Today this resistance mechanism has been recognized globally [1,2,3,4,5,6]. Many clinical microbiology laboratories have problems to detect ESBL-mediated resistance. Controversy exists regarding the clinical importance of such resistance, the choice of optimal laboratory methods to detect it, and surveillance of ESBL-producing organisms. Among the genera of Enterobacteriaceae, ESBL are most commonly produced by Klebsiella spp. and Escherichia coli [7] These enzymes have been isolated from other Gram-negative bacilli including Pseudomonas aeruginosa and Acinetobacter spp. ESBL hydrolyse penicillins and oxyiminoaminothiazolyl cephalosporins including cefuroxime, ceftriaxone, ceftizoxime, ceftazidime, cefpirome, cefepime, but not cephamycins [10,11,12,13]
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